HADS: 14 items built to ignore your physical symptoms
Most depression and anxiety questionnaires ask about sleep, appetite and fatigue. On a hospital ward those questions are close to useless, because the illness itself causes them. Zigmond and Snaith wrote HADS in 1983 for exactly that problem, with the somatic items deliberately left out. Fourteen questions: seven for anxiety, seven for depression.
Odd-numbered items belong to the anxiety subscale and even-numbered items to the depression subscale, and several are reverse-scored. Each is rated 0 to 3, so each subscale runs 0 to 21 and the two are scored separately. The original design does not produce a combined total, which trips people up when they try to compare one number to another.
Reading the two subscales
| Subscale total | Reading |
|---|---|
| 0-7 | Normal range |
| 8-10 | Suggestive of a mood disorder |
| 11 and above | Probable case |
Where 8 sits matters. Bjelland and colleagues reviewed 747 papers and found that a cutoff of 8 gave the best balance of sensitivity and specificity in general and medical populations. A 2025 Cochrane review covering 67 studies and 18,467 participants recommended 8 or above for possible anxiety and 11 or above for definite anxiety, and it is candid about the cost: out of a hypothetical 1,000 people, a cutoff of 8 flags 325, of whom 199 are false positives and 126 are true cases, while missing 44.
Reliability
In a Greek validation with 521 participants, alpha was .884 for the full scale, .829 for the anxiety subscale and .840 for the depression subscale. Retesting after 20 days gave intraclass correlations of .944, .899 and .837 respectively. In a cohort of 4,102 Chinese adults living with HIV, every subscale alpha came in above .70.
What HADS is good for, and what it is not
It is a screening instrument for medical settings, and for anyone whose physical health could muddy the picture. It is short, it has been translated widely, and it sidesteps the symptom overlap that inflates other scales in unwell people.
It is also not a diagnostic interview. A score of 8 to 10 means the subject is worth asking about, not that someone has an anxiety disorder. And because the somatic items were removed on purpose, HADS can under-read depression in people whose main symptoms are physical. If a subscale sits in the raised range, the next step is a clinician rather than a conclusion. This page is not a diagnosis and does not replace one.